Case Report of Serum Sickness-like Reaction following the First Dose of the Chimpanzee Adenovirus-Vectored AstraZeneca COVID-19 Vaccine, ChAdOx1
Abstract
:1. Background
2. Case Presentation
2.1. Examination
2.2. Investigations
2.3. Treatment
2.4. Follow-Up and Outcome
3. Discussion
4. Learning Points
- Serum sickness-like reaction is a rarely reported side effect and risk following AstraZeneca COVID-19 vaccine, but benefits of currently approved vaccines significantly outweigh their risks.
- We describe a first case in Saudi Arabia of serum sickness-like reaction following vaccination against COVID-19, in the absence of any further triggers.
- Further association studies are required to adequately determine the potentially link between COVID-19 vaccination, serum sickness-like reaction.
- Serum sickness-like reactions is a self-limiting illness usually resolve on their own within a week or two after the triggering factors have been eliminated, however, this time frame might be extended to three weeks in rare cases.
5. Conclusions
Author Contributions
Funding
Institutional Review Board Statement
Informed Consent Statement
Data Availability Statement
Conflicts of Interest
References
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Condition | Serum Sickness-like Reaction | Serum Sickness |
Causal agents |
| Agents containing heterologous (nonhuman) proteins or antigens, such as vaccines, biological therapies (immune modulators, monoclonal antibodies), equine microbial or venom anti-toxins, insect proteins, etc. |
Pathophysiology | The pathophysiology is still not elucidated. It is believed that the mechanism is drug-specific and may be due to:
| The pathophysiology involves type III (immune complex-mediated) hypersensitivity mechanism. Exposure to heterologous proteins induces an immune response with the formation antigen-antibody immune complexes. In case of reduced clearance (due to reduced function of macrophage activating system), these immune complexes settle in body tissues and joint fluids, which leads to the activation of the complement. The complement activation stimulates a histamine-mediated local inflammatory response causing the symptoms. Other mechanisms suggest the presence of complement-independent pathways for serum sickness involving the reaction of the immune complex with Fc-gamma-receptors that present on immune cells, such as neutrophils. |
Clinical presentation | ||
Time from exposure to onset | 5–10 days | 6–10 days after first exposure to the antigen, and fewer days in case of repeat exposure. |
Dermatological manifestations | Rash made of urticaria and pruritis | Urticaria, maculopapules or purpura (vasculitis). Mucus membranes are not involved. |
Rheumatic manifestations | Arthralgias, and less commonly arthritis. | Polyarthralgia and less commonly polyarthritis, involving more frequently knees, shoulders and metacarpophalangeal articulations. |
Systemic and other disorders | Fever is frequent but inconsistent and lymphadenopathies are less common. | Fever and malaise are frequent. Less common manifestations are: edema, lymphadenopathies, visual disorders, splenomegaly, nephropathy, neuropathy, etc. |
Prognosis | Resolution of major symptoms (fever, arthralgias) ~2 days after discontinuation of the causal agent. | Resolution 7–14 days after discontinuation of the causal agent. Multiples episodes due to repeat exposures to the causal agent may lead to renal failure and death. |
Biological findings |
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Alzaidi, A.A.; Alzaidi, A.A.; AlOtaibi, M.T.; Alsheikh, R.M. Case Report of Serum Sickness-like Reaction following the First Dose of the Chimpanzee Adenovirus-Vectored AstraZeneca COVID-19 Vaccine, ChAdOx1. Vaccines 2023, 11, 467. https://doi.org/10.3390/vaccines11020467
Alzaidi AA, Alzaidi AA, AlOtaibi MT, Alsheikh RM. Case Report of Serum Sickness-like Reaction following the First Dose of the Chimpanzee Adenovirus-Vectored AstraZeneca COVID-19 Vaccine, ChAdOx1. Vaccines. 2023; 11(2):467. https://doi.org/10.3390/vaccines11020467
Chicago/Turabian StyleAlzaidi, Areej Awad, Arwa Awad Alzaidi, Modhi Thaiban AlOtaibi, and Reem M. Alsheikh. 2023. "Case Report of Serum Sickness-like Reaction following the First Dose of the Chimpanzee Adenovirus-Vectored AstraZeneca COVID-19 Vaccine, ChAdOx1" Vaccines 11, no. 2: 467. https://doi.org/10.3390/vaccines11020467
APA StyleAlzaidi, A. A., Alzaidi, A. A., AlOtaibi, M. T., & Alsheikh, R. M. (2023). Case Report of Serum Sickness-like Reaction following the First Dose of the Chimpanzee Adenovirus-Vectored AstraZeneca COVID-19 Vaccine, ChAdOx1. Vaccines, 11(2), 467. https://doi.org/10.3390/vaccines11020467